Finding a BETTER way: A qualitative study exploring the prevention practitioner intervention to improve chronic disease prevention and screening in family practice

Abstract

BackgroundOur randomized controlled trial (The BETTER Trial) found that training a clinician to become a Prevention Practitioner (PP) in family practices improved chronic disease prevention and screening (CDPS). PPs were trained on CDPS and provided prevention prescriptions tailored to participating patients. For this embedded qualitative study, we explored perceptions of this new role to understand the PP intervention.MethodsWe used grounded theory methodology and purposefully sampled participants involved in any capacity with the BETTER Trial. Two physicians and one coordinator in each of two cities (Toronto, Ontario and Edmonton, Alberta) conducted eight individual semi-structured interviews and seven focus groups. We used an interview guide and documented research activities through an audit trail, journals, field notes and memos. We analyzed the data using the constant comparative method throughout open coding followed by theoretical coding.ResultsA framework and process involving external and internal practice facilitation using the new role of PP was thought to impact CDPS. The PP facilitated CDPS through on-going relationships with patients and practice team members. Key components included: 1) approaching CDPS in a comprehensive manner, 2) an individualized and personalized approach at multiple levels, 3) integrated continuity that included linking the patients and practices to CPDS resources, and 4) adaptability to different practices and settings.ConclusionsThe BETTER framework and key components are described as impacting CDPS through a process that involved a new role, the PP. The introduction of a novel role of a clinician within the primary care practice with skills in CDPS could appropriately address gaps in prevention and screening.

Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care

“…While this study also confirmed what we learned from the qualitative study associated with the BETTER trial, namely, that introducing the new role of a PP changed dynamics in primary care settings for patients, the primary care team, and other primary care providers [7], it also explored contextual nuances and shed light on different perspectives related to the implementation in a different primary care setting. Early engagement facilitated program uptake and improved the ability to better adapt the program to the needs of the participants.…”

“…The unique characteristic of BETTER is the comprehensive approach used to address a wide variety of maneuvers related to a patient’s health, such as blood results, diet, physical activity, mental health, in a one-hour prevention visit with a PP [6, 7]. While this qualitative study suggests that the implementation of BETTER 2 was valued as an opportunity to address patients’ complex and multi-faceted health care needs from a CDPS perspective, it also revealed important barriers related to implementing comprehensive preventive activities.…”

“…The BETTER trial, a pragmatic cluster randomized controlled trial, demonstrated that the prevention visits with PPs were effective in improving patients’ CDPS outcomes in the participating urban primary care settings [6]. Furthermore, a qualitative study that complemented the BETTER trial found that PPs played a key role in facilitating CDPS that benefitted both patients and primary care team members [7]. The BETTER 2 program was a second iteration based on the promising results of the BETTER trial to study the implementation of BETTER 2 as a program.…”

A Review and Synthesis of TBPCC Evaluation in Canada: Looking beyond the Quadruple Aim

“…Working to build understanding of roles and shared leadership is also widely attributed to enhancing collaboration (58,60,61,65). There is also evidence of the value of interprofessional education (67,77). Intentional, team-focused activities, including formal meetings, professional development programs, social activities, and retreats, are essential to sustaining and building relationships needed for highly functioning teams (75,78).…”

Efficacy of a Communication Skill Training Fostering Health Promotion in Primary Care: A Mixed Method Analysis

“…Finally, in the light of decreasing numbers of GPs it is crucial to invite medical practice assistants and practice nurses to join training courses and to implement counseling in collaboration with the GP and under his/her responsibility [33,34]. In our program "Health coaching" we recently started this initiative.…”